Wenjia Wang MD, Presenter: Nothing to Disclose

Michael J. Shortsleeve MD, Abstract Co-Author: Nothing to Disclose

Our department utilizes a combination therapy of intravenous glucagon, effervescent crystals, and water to treat acute esophageal food impactions in the emergent setting. We present our results from 109 consecutive completed procedures performed from 2002 to 2013.

Patients with acute food impactions (less than 24 hours duration) in the esophagus were selected. Single contrast esophagrams were performed with 5 ml of undiluted non-ionic water-soluble contrast to confirm the presence and location of food impactions. Patients were then administered 1 ml of IV glucagon, one packet of E-Z Gas, and 240 ml of water. A second single-contrast esophagram was obtained to evaluate food bolus clearance and to exclude perforation. From 2002 to 2013, we performed 130 consecutive procedures, of which 21 were excluded for premature abortion due to patient vomiting.

The therapy resulted in 57 successful (excluding 3 which resolved within 30 minutes later in the emergency room and 9 which resolved following the initial contrast bolus alone) and 36 unsuccessful procedures with a success rate of 61%. In addition, 3 showed partial food clearance and 1 showed food bolus movement without clearance. The majority of impactions were ingested meat (94%, n=87). The most common underlying abnormality found was a lower esophageal ring, measuring 12.3 cm in the successful group and 11.4 cm in the unsuccessful group (n=19, excludes 19 with a documented ring but no measurement). Other causes included dysmotility, reflux esophagitis, Candida esophagitis, stricture, and esophageal adenocarcinoma. Combined with our previous data from 1987 to 1993 of 33 successful and 15 unsuccessful consecutive completed procedures, our total success rate is 64%. One complication of mucosal laceration occurred after two consecutive treatments in the same patient from the previous data.  

The combination therapy is both successful and safe in treating acute esophageal food impactions in the emergent setting with minimal complications and radiation.

The above described combination therapy is unique to our department and demonstrates the highest success rate to our knowledge in published literature for the fluoroscopic treatment of acute esophageal food impactions. Our study subject number is also the largest of its kind.

Wang, W, Shortsleeve, M, Fluoroscopy-Guided Treatment of Acute Esophageal Food Impactions in the Emergent Setting.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14045530.html